APPLICANT'S ABSTRACT: This proposed 5-year study compares the long-term effects of an Enhanced-Cognitive-Behavioral (E-CB) Intervention to a Standard Care (SC) comparison condition in reducing the risk of HIV transmission risk behaviors among a culturally diverse, lower-SES, sexually-active, recovering Alcohol or Other Drugs (AODs) abusing population of 320 Severely Mental Ill (SMI) women and men. The study is a randomized (by cohort), two-group design with repeated measures over time (6 and 12 month follow-up) comparing the efficacy of E-CB with SC in psychiatric treatment. Although there have been a few randomized HIV prevention outcome studies in the SMI population, these studies did not focus on reducing AOD use and other putative psychiatric mediators of HIV transmission risk behavior. This study is significant because it addresses the urgent need to develop an effective intervention to reduce HIV transmission risk and AOD use in a growing population of SMI patients in treatment and it focuses on overcoming several neglected issues of practical significance. Of importance, this study employs a standardized psychosocial E-CB intervention that has been specifically gender-tailored for the target population and attempts to reduce risky behavior in an SMI group that includes HIV + individuals. Using multivariate methods, we will assess whether: 1) E-CB reduces HIV risk behaviors to a greater extent than SC; 2) E-CB reduces AOD use and other psychiatric symptoms' indices to a greater extent than SC; 3) AODs use, other psychiatric symptoms, and HIV-specific risk variables (e.g., self-efficacy, condom skills) are mediators of outcome; and 4) key variables (e.g., tramatic abuse history, neuropsychological functioning, gender) are moderators of outcome. Secondary analyses (Hierarchical Linear Modeling, Structural Equations) will explore cause models of how important variables (e.g., psychiatric diagnosis and symptoms, AOD and HIV attitudes, beliefs, skills) may interact to predict HIV transmission risk behavior. If successful, this research will provide important new intervention strategies that can be practically implemented with recovering AOD abusing SMI psychiatric outpatients. The proposed project will contribute new and unique information about the effects of gender, serostatus, neuropsychological functioning, AOD abuse, psychiatric symptoms and other putative mediators/moderates of HIV transmission risk outcome among SMI patients.